If a resident with severe dementia refuses to go to bed, is it alright to leave her in the lounge overnight?

Answered by Geraldine McMurdie

This is not ideal, and you should be looking at potential reasons why the resident may be declining rather than “refusing” to go to bed.

There are several areas to explore to try and establish a sleep routine. Good quality sleep is essential for wellbeing, so sleeping in the lounge is not a long-term solution and is likely to lead to other issues such as the risk of falls, irritability, and more confusion.

I have several questions and suggestions:

1. Do they always decline to go to bed every night, or just some nights? If so, what is different on the nights they went to bed? This may help in understanding what is helpful.

2. What was their bedtime routine before the onset of dementia? Is it too early for them to go to bed? This information should be part of their personal profile. If not, can they ask family about the bedtime routine, as this may be helpful?

3. Are they active in the day? It’s particularly important to spend time getting sunshine and daylight, as this helps to set the body’s internal clock. Based on this feedback, you could try to put in a regular bedtime routine that is consistently adopted by all care staff. Time-shifting or disruption of the body clock is common in all dementias.

Can the resident sit in the lounge with the radio or calming music on low volume, and have a member of staff sit with them, have a bedtime cup of cocoa (or their preferred bedtime drink) and help them reset for bedtime? After about 5–10 minutes, make gentle suggestions about feeling tired or sleepy to prompt: “How do you feel about going to bed?” Use a gentle tone and language that suits the resident. Avoid it sounding like a command, so the resident feels in control. This may need to be repeated after about 10 minutes, so be prepared for this.

4. Do they feel more comforted being around people? Is there an unmet need for comfort? Perhaps using a comfort doll or pet may help them relax before bedtime, and they can take it to bed with them.

5. Are there other unmet needs – pain, hunger or thirst, uncomfortable clothes or bedding?

6. Have they considered if there is anything in the room that may be causing distress? Mirrors, shadows or pictures that may be misinterpreted could be removed or put in their wardrobe. Lighting and environment adjustments can remove shadows, or having dimmed lighting placed carefully may help.

7. Are they taking any medications that can affect their sleep? Discuss with the GP and review.

8. Do they experience hallucinations? This is common in Dementia with Lewy Bodies. They should speak to their GP about this, as a referral to the Older Person’s Mental Health Team is recommended.

9. If this persists after trying these measures, or the situation gets worse, a referral to the Older Person’s Mental Health Team is recommended.

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